Recovery From Schizophrenia: Psychiatry And Political Economy

154 SCHIZOPHRENIA IN THE THIRD WORLDsymptoms and 40 per cent showed no deficits in working ability. The patientsfrom rural areas did better than those from the cities. 29 Followed up after tenyears, the people in the Madras sample were still doing as well as five years earlier. 30NigeriaOne hundred and sixteen patients with schizophrenia and schizophreniformdisorder newly admitted to a psychiatric unit in Oyo State, Nigeria, in 1982–83were followed up after two to three years by psychiatrist Roger Makanjuola andsocial worker Sunday Adedapo. Nearly half had recovered completely and threequartershad a good clinical outcome. Sixty per cent were back at work. 31BaliA comparative study of five-year outcome for patients with schizophreniaadmitted to hospitals in Bali, Indonesia, and Tokyo, Japan, in 1990–92 foundinteresting differences between the two small cohorts of patients. Average levelsof psychopathology were similar in the two groups, but the duration of hospitalstay in Bali was less than a quarter of the duration in Tokyo, the proportion of thesample taking medication at follow-up was only 25 per cent in Bali versus 85 percent in Tokyo, and hospital readmission rates were lower on the Indonesianisland. The Balinese patients were admitted to Bangli State Mental Hospital whichcontained nearly all the psychiatric beds on the island. Despite the very smallnumber of available beds, the hospital was less than two-thirds full, suggesting thatit was a place of last resort for difficult patients who could no longer be managedin the community. This observation may explain why the outcome for the Balinesepatients was not as clearly superior as it was for some of the other Third Worldstudies described here. 32WHO INTERNATIONAL PILOT STUDY OFSCHIZOPHRENIAA problem with attempts to compare recovery rates in different parts of the worldis that research studies vary in the way patients are selected and diagnosed and inthe criteria used for measuring outcome. To clarify this picture the World HealthOrganization international, collaborative follow-up study of schizophrenia 33brought standardized methods of diagnosis and follow-up to the analysis ofoutcome for psychotic patients from nine countries in the industrial and nonindustrialworld. Patients admitted to psychiatric centers in Aarhus (Denmark),Agra (India), Cali (Colombia), Ibadan (Nigeria), London (UK), Moscow (USSR),Prague (Czechoslovakia), Taipei (Taiwan), and Washington, DC (USA) wereevaluated according to a standardized procedure and categorized by acomputerized diagnostic scheme—the CATEGO system. By this method, groupsof very similar cases of acute and chronic schizophrenia were selected in each of